Cysticercosis of the eye

An Interesting Case Report on a Myocysticercosis Cyst

One of the most dangerous parasite infections, cysticercosis, is found practically everywhere in the world. Cysticercus cellulosae is the larval stage of the swine tapeworm Taenia solium, which causes cysticercosis. Orbital or ocular cysticercosis (OOC) is an avoidable cause of blindness. There are two types of ocular cysticercosis: intraocular (in the anterior chamber, subretinal space, or vitreous) and extraocular (in the orbital tissues or subconjunctival space). Here, we report a rare case of extraocular muscle cysticercosis that presented as a solitary, well-defined lobulated mass near the medial canthus in the right eye and was well managed medically with antihelminthic drugs and corticosteroid therapy. The key to diagnosing myocysticercosis is orbital imaging. Although brain and ocular involvement in cysticercosis is common, extraocular muscle cysticercosis is extremely uncommon and mainly affects young people and children. Orbital pseudotumor, idiopathic myositis, and hydatid cysts are a few differential diagnoses for ocular cysticercosis. It is critical to recognize and treat such illnesses as early as feasible to avoid serious consequences. Public health measures are essential to eradicate this disease in the area.

Infectious eye disease in the 21st century-an overview

Infectious diseases affecting the eye often cause unilateral or asymmetric visual loss in children and people of working age. This group of conditions includes viral, bacterial, fungal and parasitic diseases, both common and rare presentations which, in aggregate, may account for a significant portion of the global visual burden. Diagnosis is frequently challenging even in specialist centres, and many disease presentations are highly regional. In an age of globalisation, an understanding of the various modes of transmission and the geographic distribution of infections can be instructive to clinicians. The impact of eye infections on global disability is currently not sufficiently captured in global prevalence studies on visual impairment and blindness, which focus on bilateral disease in the over-50s. Moreover, in many cases it is hard to differentiate between infectious and immune-mediated diseases. Since infectious eye diseases can be preventable and frequently affect younger people, we argue that in future prevalence studies they should be considered as a separate category, including estimates of disability-adjusted life years (DALY) as a measure of overall disease burden. Numbers of ocular infections are uniquely affected by outbreaks as well as endemic transmission, and their control frequently relies on collaborative partnerships that go well beyond the remit of ophthalmology, encompassing domains as various as vaccination, antibiotic development, individual healthcare, vector control, mass drug administration, food supplementation, environmental and food hygiene, epidemiological mapping, and many more. Moreover, the anticipated impacts of global warming, conflict, food poverty, urbanisation and environmental degradation are likely to magnify their importance. While remote telemedicine can be a useful aide in the diagnosis of these conditions in resource-poor areas, enhanced global reporting networks and artificial intelligence systems may ultimately be required for disease surveillance and monitoring.

Worm in the Eye: A Case Report of Ocular Neurocysticercosis With Adherent Retinal Cyst

Neurocysticercosis is caused by cysticercus cellulosae, the larval stage of Taenia solium, commonly referred to as the pork tapeworm. These larvae form cysts in several organs, including the brain, spinal cord, and eye. Neurocysticercosis is recognized by the World Health Organization as a public health issue and stands as the foremost preventable cause of epilepsy worldwide. Ocular neurocysticercosis refers to the concurrent involvement of the eyes and brain with cysticercus lesions. Neurological symptoms include focal deficits, intracranial hypertension, or cognitive decline. In the eye, the orbital type commonly presents with periocular swelling, ptosis, diplopia, restriction of ocular motility, or decreased vision. The ocular type shows signs of retinal detachment, a macular hole, and inflammation. A 45-year-old female presented with pain in his right eye with blurred vision for 15 days. On USG and MRI of the eye, a thin-walled lesion was noted. The brain showed a few calcified granulomas in the right parietal lobe on MRI. The left eye was normal. If left untreated, the cysts can lead to a severe inflammatory reaction in the eye, which may eventually lead to blindness. This blindness caused by cysticercus is preventable, and hence, early diagnosis and prompt medical or surgical treatment are essential.

Intraocular twin cysticercosis

A 20-year-old vegetarian male presented with a history of painful diminution of vision in the right eye for the past month. The patient had dense vitritis. B-scan ultrasonography (USG) revealed two cysts with scolices, one subretinally along with retinal detachment and another one in vitreous cavity. Orbital USG revealed no cystic lesions in the orbit or extraocular muscle. He underwent 23 gauge pars plana vitrectomy. Both intravitreal and subretinal cysts were cut and aspirated using cutter and removed from the eye, and silicon oil was injected. Postoperatively he was started on oral steroids and advised to maintain prone positioning for two weeks. At two months his best corrected visual acuity (BCVA) in the right eye was 20/125 with silicon oil in situ.

Paediatric orbital ultrasound: Tips and tricks

Background

The orbital structures are ideally suited for ultrasound examination due to their superficial location and cystic composition of the eye. However, orbital ultrasound remains an underutilised modality due to preference for other cross-sectional modalities in general practice.

Aim

In this article, we review the basic principles, clinical uses and technique of orbital ultrasound in peadiatric patients.

Materials and methods

The clinical utility of orbital ultrasound in peadiatric patients is demonstrated using selected cases.

Results

Ultrasound is useful in the diagnosis of various posterior segment pathologies, especially in conditions causing opacification of light-conducting media of the eye. It is also beneficial in diagnosing various orbital pathologies, particularly in differentiating solid from cystic lesions.

Discussion

The added advantages of its use in children include lack of ionising radiation and reduced requirement of sedation or general anesthesia. Ultrasound is the most practical initial investigation in cases where ophthalmoscopy is limited by opacification of ocular media. The addition of color Doppler on ultrasound can give additional information about the vascularity of the lesion.

Conclusion

Use of ultrasound can be streamlined into the workup of various orbital and ocular pathologies either as an initial investigation or as a problem-solving tool in cases with a diagnostic dilemma on other modalities.

Subconjunctival cysticercosis - Is surgery always indicated? Role of medical management-literature review and report of two cases

Ocular cysticercosis is caused by the larval form of pork tapeworm for which humans and pigs are the intermediate hosts. Intense inflammation secondary to immunological reaction is the hallmark feature of the infection, which can affect almost any tissue of the host. Orbital imaging yields specific features suggestive of the diagnosis. Although medical management is the recommended treatment for extra-ocular and retro-orbital cysticercosis, surgical removal has also been suggested by several authors. Here, we report two cases of subconjunctival cysticercosis, successfully managed with medical treatment alone using oral steroid and albendazole. Surgical excision for subconjunctival cysticercosis is associated with complications which can be observed even with the most experienced hands. Through these two cases, we wish to sensitize the practicing physicians regarding the most common ocular infestation seen in the developing countries along with brief literature review on the management protocols to be followed before any surgical reference.

Case of Orbital Cysticercosis Presenting as Recurrent Cellulitis Diagnosed on Multi-Modality Imaging

Cysticercosis results in humans when infected with the larval stage of taenia solium which is called cysticercus cellulosae. The target organs usually involved are the brain, eyes, spine, and skeletal muscles. The ocular form of cysticercosis can affect the intra-ocular structures or involve the orbital adnexa. Intraocular involvement is relatively common and is readily diagnosed owing to its obvious visibility on a basic slit-lamp examination, however, affection of orbital adnexa is infrequent. Moreover, solitary involvement of one of the extraocular muscles is rare and difficult to diagnose as it presents with a spectrum of non-specific symptoms. We report a rare case of orbital cysticercosis with a solitary left superior rectus muscle involvement, who presented with recurrent on and off lid swelling extending for two years with double vision and restriction of downward gaze.

Taenia solium in the Anterior Chamber: Surgical Management of a Rare Case of Live Free-Floating Parasite

Ocular cysticercosis is a preventable cause of blindness. It is a parasitic infestation caused by Cysticercus cellulosae—which is the larval form of Taenia solium. In 1829, Soemmering reported the first case of a live anterior chamber cysticercosis. In the following, we report a rare case of a 13-year-old male who presented with a live adult Taenia solium in the anterior chamber without any systemic features and its successful management.

Nightmares with a starry sky - Treating neurocysticercal encephalitis, how far to go

Cysticercosis, an infection caused by the larval stage of tapeworm Taenia solium, is the most common parasitic disease of the human nervous system and the single most common cause of acquired epileptic seizures in the developing world. Here, we describe the stormy course of a 67-year-old female with neurocysticercosis (NCC) having a recurrent encephalitic presentation. She went through the most severe spectrum of this disease, namely NCC encephalitis and disseminated cysticercosis and had a classical starry sky brain in neuroimaging. In contrary to the popular practice of avoiding antihelminthic drugs in such extreme presentation, as a desperate measure, we had to use albendazole in this case, which showed clinical and radiological improvement.

Myocysticercosis as a Rare Cause of Hand Swelling involving Thenar Group of Muscles: A Case Report

Larval form of Taenia solium causes cysticercosis that commonly involves the central nervous system. Other sites of manifestation are eye, gastrointestinal system, skeletal muscles and subcutaneous tissues. Isolated muscular involvement is rare with only a handful of cases reported in the literature. We present this case of an isolated symtomatic hand swelling due to Myocysticercosis which pose diagnostic dilemma. This should be considered in differential diagnosis in our developing nation and especially in endemic region. High resolution ultrasound of the hand (thenar region) helped in the diagnosis and is often diagnostic like in our case. The treatment of choice of an isolated symptomatic lesion without involvement of central nervous system is surgical excision which we did followed by short course of antiheminthic and anti-inflammatory medication for two weeks.

Surgical Management of Extraocular Muscle Cysticercosis Causing Optic Foramen Syndrome

Extraocular muscle cysticercosis usually presents with proptosis and restriction of eyeball movements. However, it can cause vision loss by compression of the optic nerve at the optic foramen in infrequent circumstances. We report a rare case with an unusual manifestation of ptosis, proptosis, lateral rectus palsy, and acute vision loss in the right eye. Magnetic resonance imaging was suggestive of cysticercal cyst. Emergency optic nerve decompression with cyst excision was done. Treatment of choice for extraocular muscle cysticercosis presenting with restriction of eyeball movements is mainly medical, consisting of albendazole and steroids. However, as this lesion rarely causes vision loss, indications of surgical decompression of optic nerve are not well defined. We recommend that early surgical management should be done along with medical treatment in cases of vision loss caused by extraocular muscle cysticercosis.

A rare case of giant subretinal migration of cysticercosis cyst with extensive epiretinal membrane and subretinal fibrosis

Cysticercosis is caused by cysticercus cellulosae, the larval form of pork tapeworm. In intraocular cysticercosis the cyst enters the subretinal space via the choroid and then gains entry into the vitreous cavity by piercing the retina. It is well established that the cyst can incite extensive intraocular inflammation. Other complications such as epiretinal membrane and cataract have been reported in the literature. Thus far, epiretinal membrane in intraocular cysticercosis has been reported at the site of entry of the cyst into the vitreous cavity. The data on the extent of epiretinal membrane is sparse. We report a rare case of migrating subretinal cysticercosis with extensive epiretinal membrane and subretinal fibrosis.

Acute isolated medial rectus palsy due to infarction as a result of hypercoagulable state: A case report and literature review

Isolated medial rectus palsy in an otherwise healthy individual is a very rare entity. However, this may point towards underlying systemic pathology. This is a case report of an otherwise healthy young adult male who presented with sudden onset non-progressive blurring of vision in right eye. A series of investigations were performed and the patient was diagnosed to have a rheumatological disorder. Isolated muscle palsies in young patient may be masking a systemic disorder and needs to be evaluated thoroughly.

Orbital cysticercosis

A young male patient presented to our ocular emergency department with chief complaints of progressive pain, redness, diplopia and a right-sided face turn. Ocular examination revealed severely restricted extraocular movements along with retinal folds in the left eye. Initial orbital ultrasound and CT findings were equivocal; however, serology favoured an infective cause. Considering the endemicity of the disease and equivocal investigation findings, a diagnosis of orbital cysticercosis with an atypical presentation was made. The patient was managed medically with a combination of oral albendazole and steroids over a period of 6 weeks to achieve optimal results.